Terminal servers are traditionally used in a heath care setting by connectivity servers (e.g., CareAware® iBus) to facilitate MDI (e.g., laboratory devices) connectivity to a healthcare information system (which may include an EMR). Typically, medical devices (e.g., laboratory devices) utilize serial interface ports to connect to the terminal servers. The terminal servers are disparate systems that provide raw network socket connections to serial interfaces on the medical devices. Upon connecting the medical devices, terminal servers utilize TCP interface ports to provide basic serial to TCP conversion capability and facilitate communication from the medical devices to the healthcare information system. However, current terminal servers are utilized with unauthenticated TCP port access with no restrictions on what addresses can access each port. Human error or malicious intent can result in multiple foreign systems trying to access the same TCP port, which results in missing or spotty data.
Hardware can be difficult to obtain and many of the terminal server designs have had no significant updates to the hardware or software. Many terminal servers in production today have a single 10BaseT Ethernet. The 10 MHz speed translates to 10 Mbit per second, which in theory means 1.2 Mbps. In practice though, the current terminal server is limited to no more than 800 kilobits per second (Kbps) because the 10BasetT Ethernet runs at half-duplex. Although that is sufficient bandwidth for serial devices running at 9600 bits per second, the half-duplex nature along with the limited processing power, makes these terminal servers susceptible to denial of service (intentional or unintentional), especially if network designs are not taking into consideration this risk.
However, terminal servers are very simple devices that require a signification amount of manual configuration, often using proprietary software or non-intuitive command line interfaces to configure, receive status updates, and reset serial port connections. Moreover, the TCP interface ports are not managed which can result in a loss of connectivity, which is not easily recognized until a clinician searches the EMR and realizes the data is missing. Even when it is determined that a loss of connectivity has occurred, clinicians are not equipped to troubleshoot the terminal server via proprietary software or command line utilities. Accordingly, support requests must be generated and routed through a support system until someone properly trained to troubleshoot the terminal server is available and on-site. This level of support results in numerous support requests for changes and simple management tasks which increases costs and time delays to support and manage the terminal servers.
Issues related to terminal servers have led to an implementation shift. In an effort to minimize network related impacts on the reliability of the terminal server, more hardware has been placed closer to the terminal server. For example, a CE appliance or a SOAD server are sometimes utilized to servers to connect the terminal servers to a bus that supports the healthcare information system. Although the additional hardware has helped to reduce some of the support related issues, the hardware costs have significantly increased.